Vibrating guidewire

ABSTRACT

The invention is directed to a hand held vibration device which imparts reciprocating motion in a guidewire while leaving the guidewire free to rotate about its longitudinal axis, to facilitate advancement of the guidewire through a highly occluded blood vessel. The vibrating device is provided with a lock ring for reversibly preventing guidewire rotation without effecting guidewire reciprocation, and the reciprocation length of the device may be varied. The length the guidewire extends past the distal end of a delivery catheter may be varied from controls on the device which do not require guidewire detachment from the reciprocating mechanism. The device may be used with or without a delivery catheter provided with a curved distal end, the curvature of which can be varied while the catheter is inside the patient.

BACKGROUND OF THE INVENTION

This invention relates to the field of medical devices, and moreparticularly to a guidewire system for advancement through a highlyoccluded blood vessel.

Atherosclerosis resulting in a blockage of arteries can be a lifethreatening disease. Percutaneous intravascular procedures such asangioplasty and atherectomy were developed to open blocked vessels withas little trauma as possible. Angioplasty involves inflating a balloonpositioned within the obstructive deposits or stenosis in the vessel, sothat the stenosis is compressed against the arterial wall and the wallexpanded to open up the passageway. Atherectomy involves selectiveexcision and removal of obstructive deposits from the vessel walls.

An essential first step in these percutaneous procedures is maneuveringthe distal operative extremity of the angioplasty or atherectomycatheter into position at a precise point inside the arterial occlusion.Maneuvering through small branched vessels and the stenosis itself canbe very difficult and tedious. Especially difficult in this respect arechronic total occlusions (CTO). While most CTOs are not totallyobstructed, only a small tortuous channel passes through the stenosis.

The guidance system used to position the catheters must be botheffective and safe, because if they cannot be positioned precisely intoplace, the stenosis cannot be treated. Additionally, inadequate guidancecarries a risk of perforation of the vessel that exceeds the benefits ofrecanalization.

The use of a guidewire is ideal in terms of effectiveness, safety,simplicity, and cost. Typically, a guiding catheter is inserted into thepatient's aorta with its distal tip seated in the ostium of the desiredcoronary artery. The guidewire is then maneuvered into place while itsprogress is fluoroscopically monitored. Once the guidewire passesthrough the stenosis, the angioplasty or atherectomy catheters can beadvanced over the guidewire and into place within the stenosis.

The distal end of the guidewire may be shaped, e.g. bent, at an angle upto 90° from its longitudinal axis, so that torquing the proximal end ofthe guidewire from outside the patient can guide the distal tip of theguidewire into branch arteries. While it is known that vibrating aguidewire can help its passage through an occluded artery, suchvibration has not been shown to be successful in highly occludedpassageways such as CTO's.

What has been needed is a vibration device with the superior guidewiresteerability and ease of use which results from having the guidewirefree to rotate or move longitudinally relative to the distal tip of aguiding catheter even though the guidewire is attached to the vibratingmechanism. By providing for simultaneous manipulation of more than onevariable of the guidewire, such a device gives the operator greatercontrol over the guidewire position. Furthermore, such a device wouldhave superior ease of use because unclasping, repositioning, andreclasping the guidewire to the vibration mechanism would not berequired each time the guidewire needed to be rotated or moved relativeto the guiding catheter.

Additional guidewire control would be provided by a guiding catheterwith a bend in the distal tip which could be varied incrementally from0° to 90° from its axis, while the catheter was inside a patient vessel.When attached to a vibrating device, a catheter with such in situvariability would allow the distal end of the guidewire to oscillate ata variety of angles to the longitudinal axis of the catheter, and wouldbe useful in accessing off-center channels and side branches.

The vibration device of the present invention provides such acombination of desirable properties.

SUMMARY OF THE INVENTION

The present invention is directed to a guidewire vibration device foruse with or without a guidewire guiding catheter, to aid in advancementof a guidewire through a patient vessel. The vibration device of theinvention generally has a guidewire tube reciprocally driven by a motor,designed to provide superior steerability in a reciprocating guidewire.

The vibration device has a housing, an electric motor within thehousing, and a cam attached to the motor which translates the motor'srotational output into repetitive linear motion. A reciprocating memberattaches to the cam to vibrate with a pivoting action. A tube isattached to the reciprocating member so that the tube reciprocates withthe reciprocating member along the tube's longitudinal axis but remainsfree to rotate around the longitudinal axis. A suitable connection is aball and socket joint formed by a ball on the tube which fits into asocket on the reciprocating member. A guidewire threads through thelumen of the tube, and is releasably attached to the proximal end of thetube.

The rotation of the guidewire tube may be unchecked, or a lockingmechanism may be used. A suitable locking mechanism reversibly locks therotational motion of the tube by adjusting the circumference of anopening through which the guidewire tube extends. When narrowed, theopening is large enough to allow the tube to clear when reciprocatinglongitudinally but too small to allow comers of the tube to clear iftube rotation is attempted.

In accordance with a further development of the invention a fittingattaches a guiding catheter to the vibration device. The fitting allowsthe guiding catheter to be reversibly extended or retracted while inuse, thereby varying the length that the guidewire extends beyond thedistal tip of the catheter without requiring detachment of the guidewirefrom the vibration device. A suitable fitting has a rotating luer ringthreaded onto a distal side of the device, and a tubular support memberwith a proximal end attached to the rotating luer ring and a distal endattached to a luer fitting which releasably connects a guiding catheterto the tubular member. Rotation of the luer ring imparts longitudinalmovement in the catheter but not in the guidewire.

In accordance with a further development of the invention, the vibrationdevice has a variable stroke mechanism that varies the fulcrum of thereciprocating member to vary the reciprocation length. A suitablemechanism has a rotating cap threaded onto the vibration device, and apivot block attached to the reciprocating member and the underside ofthe rotating cap. When the cap is rotated, the pivot block is displacedand the fulcrum of the reciprocating member is shifted, thereby varyingthe angle at which the reciprocating member pivots.

In a preferred embodiment, the vibration device may be used incombination with a guidewire guiding catheter that has supportcharacteristics which can be varied while inside the patient's vessel.The guiding catheter has an outer tubular member and a inner tubularmember slidably disposed within the lumen of the outer tubular member.The distal extremity of the inner tubular member is provided with acurved end which can be reversibly straightened by retracting the innertubular member distal tip into the distal end of the outer tubularmember. The inner tubular member is formed of a plastic material havinga modulus of elasticity such that the curve at the distal tipstraightens under applied force and subsequently returns when the forceis removed. The proximal end of the inner tubular member is attached tothe vibration device in a position to receive the guidewire.

The vibration device of the invention provides for ease of use andsuperior control in advancing a guidewire through a patient vessel. Thisis due to the ability to rotate the guidewire and vary the length thatthe guidewire extends beyond the distal tip of the guiding catheter,while the guidewire is still attached to the vibrational mechanism. Withprior devices the guidewire could not be manipulated independently ofthe vibration device, so the operator would have to loosen the clampingmechanism that holds the guidewire to the vibration mechanism,reposition the guidewire, and then reclamp the guidewire to thevibration mechanism. Additionally, the guidewire position inside thevessel could not be manipulated very well with the prior devices becausethe guidewire would not be vibrated simultaneously with the othermanipulations such as rotation. Furthermore, the tediousness ofrepeatedly releasing, repositioning, and reattaching the guidewire tothe vibration mechanism adds to operator fatigue and possibly operatorerror or engagement with an unsterile area thereby requiring theoperator to start over from the beginning with a new sterile guidewire.

The guidewire steering is further optimized by the use of the guidingcatheter with a distal tip angle of curvature which can be varied whileinside the patient vessel. By enabling the distal end of the guidewireto oscillate at a variety of angles to the longitudinal axis of thecatheter, this in situ variability allows off-center channels and sidebranches to be accessed which otherwise would have been difficult orimpossible to enter. These and other advantages of the invention willbecome more apparent from the following detailed description of theinvention and the accompanying exemplary drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an elevational schematic view of a guidewire vibration deviceembodying features of the invention.

FIG. 2 is a transverse cross-sectional view of the guidewire deliverycatheter shown in FIG. 1 taken along lines 2--2.

FIG. 3 is a transverse cross-sectional view of the guidewire deliverycatheter shown in FIG. 1 taken along lines 3--3.

FIG. 4 is a transverse cross-sectional view of the guidewire deliverycatheter shown in FIG. 1 taken along lines 4--4.

FIG. 5 is an enlarged longitudinal cross-sectional view of the proximalend of the guidewire delivery catheter shown in FIG. 1.

FIG. 6 is an elevational schematic view of a guidewire delivery catheterconfigured for manual vibration, illustrating the inner tubular memberextending out the outer tubular member.

FIG. 7 is an enlarged view of the distal end of the guidewire deliverycatheter shown in FIG. 1 illustrating the inner tubular member extendingout the outer tubular member.

FIG. 8 is an enlarged view of the distal end of the guidewire deliverycatheter shown in FIG. 1 illustrating the inner tubular member withdrawninto the outer tubular member.

FIG. 9 is a cross-sectional view of the guidewire vibration device shownin FIG. 1.

FIG. 10 is a fragmentary cross-sectional view of the device of FIG. 1illustrating a reciprocating lever and a pivot block.

FIGS. 11 and 12 are transverse cross-sectional views of the rotatinglock ring shown in FIG. 10.

FIG. 13 is a fragmentary cross-sectional view of the rotating lock ringshown in FIG. 10 in the unlocked position.

FIG. 14 is an elevational schematic view of the device shown in FIG. 1illustrating the action of the rotating luer ring imparting motion tothe delivery sheath.

DETAILED DESCRIPTION OF THE INVENTION

A guidewire vibration device 10 embodying features of the invention isillustrated in FIG. 1, and generally includes a housing 11 connected toa guidewire tube 12 having a lumen configured to slidably receive aguidewire 13 suitable for advancement through a patient's coronary andperipheral blood vessels.

Referring to FIG. 1, a presently preferred embodiment of the inventionincludes a delivery catheter 14 which may be attached to the vibrationdevice 10 to facilitate directing the catheter operative end to adesired location. FIGS. 2-4 illustrate transverse cross-sections of thedelivery catheter 14 taken along FIG. 1 lines 2--2, 3--3, and 4--4respectively. The delivery catheter 14 has an outer tubular member 16and an inner tubular member 17 disposed within the outer tubular memberlumen 18. The inner tubular member 17 has a lumen 19 extending thereinwhich is configured to slidably receive the guidewire 13. A stiffeningrod 20 may be provided within the outer tubular member lumen 18 to addrigidity to the outer tubular member 16. Strain relief tubing 21 mayalso be provided for added support at the proximal end of the outertubular member 16. An annular space 15 is defined by the part of theouter tubular member lumen 18 existing between the inner 17 and outer 16tubular members, and may provide a channel for introducing a liquid outthe distal end of the catheter.

As can be seen in FIG. 1, the outer tubular member 16 may have aradiopaque metal tip marker 22 on its distal end for fluoroscopicobservation of the tubular member, and may have printed brachial 24 andfemoral 26 markings. The inner tubular member 17 may also have aradiopaque metal tip marker 23 on its distal end. More than onedurometer may be spliced together so as to form a variable stiffnesscatheter (not shown).

In the presently preferred embodiment shown in FIG. 5 the inner tubularmember 17 is longer than the outer tubular member 16 and extends througha cylindrical member 30, a hollow support member 31, and terminates atits proximal end in a centerport adapter stem 32. Hollow support member31 can be fixed to centerport adapter stem 32 by any convenient means,e.g., by cementing the two together. The inner tubular member 17 liesinside the hollow support member lumen 33 of the hollow support member31 which is slidably received in the cylindrical member lumen 34. Thecylindrical member 30 functions in part as a carriage in which thehollow support member 31 and inner tubular member 17 disposed thereinare free to move along an axis parallel to the guidewire's 13longitudinal axis. The cylindrical member 30 and outer tubular member 16remain stationary as the inner tubular member, hollow support member 31,and vibration device 10 move longitudinally. In the embodiment shown inFIG. 5, the cylindrical member 30 is a Y-connector having a hollow sidearm 40 for introducing a liquid to the annular space 15 of the outertubular member lumen 18. Any suitable connector 36 may be used toconnect the cylindrical member 30 distal end to the outer tubular memberproximal end directly, or including strain relief tubing 21 connected tothe outer tubular member 16. This allows the inner tubular member 17 tobe moved independently of the outer tubular member 16 so that the innertubular member distal end can be extended and retracted beyond the outertubular member distal end.

The distal end of the hollow support member 31 may have an enlargement37 which is larger than the port 38 at the proximal end of thecylindrical member 30 which acts as a stop to prevent the hollow supportmember 31 from fully disengaging from the cylindrical member 30. While aTouhy-Borst connector 39 is shown in FIG. 5 connecting the hollowsupport member 31 to the cylindrical member 30, any suitable connectormay be used. FIG. 5 shows a luer connector 42 securing the proximalextremity of the delivery catheter 17 to the vibration device 10,although any suitable connector may be used.

FIG. 6 illustrates the delivery catheter 14 configured for use in manualguidewire vibration, in which case a Touhy-Borst connector 43 isprovided in place of the aforementioned luer connector 42 at theproximal extremity of the delivery catheter 14.

The distal end of the inner tubular member 17 has a preformed curve 46bent at an angle up to 90° from its axis, and the inner tubular memberis formed of a flexible plastic material having a modulus of elasticitysuch that the curve 46 at the distal end straightens under applied forceand subsequently returns to its original shape when the force isremoved. As shown in FIG. 7, when the inner tubular member 17 is fullyextended out the distal end of the outer tubular member 16, its distalend is curved. FIG. 8 shows that withdrawing the inner tubular member 17into the outer tubular member 16 straightens the curve at the distal endof the catheter.

The extent to which the inner tubular member 17 is extended beyond thedistal end of the outer tubular member 16 controls the degree to whichthe distal end is bent. In a presently preferred embodiment, the innertubular member 17 is of a length such that it can extend a maximum ofabout 3 centimeters past the distal end of the outer tubular member 16.When the inner tubular member 17 is extended or retracted relative tothe outer tubular member distal end, the guidewire 13 position relativeto the inner tubular member 17 does not change when the guidewire issecured to the vibration device 10.

The delivery catheter 14 may be formed of materials common in deliverycatheter design. The inner 17 and outer 16 tubular members may be madeof any number of polymeric materials, and the inner and outer tubularmembers preferably possess a low coefficient of friction with respect tooneanother to facilitate the advancement of the inner tubular member 17and that of the guidewire 13 as well. An alternative embodiment (notshown) including an outer tubular member made up of a plurality of tubelengths of different diameter, where each proximal tube has a diameterlarger than the tube distal thereto so that they may be inserted oneinto the other, may be used to provide a delivery catheter with variablerigidity

The internal components of the vibration device 10 shown in FIG. 1 arebest illustrated in FIGS. 9 and 10. Referring now to FIG. 9, the housing11 has an interior chamber 50 containing a motor 51 with a rotary outputshaft 52. The motor output shaft 52 turns a cam 53 which travels in anorbital motion. The cam 53 imparts reciprocating motion to areciprocating member 54, the guidewire tube 12, a collet 56, and aguidewire 13 positioned within the guidewire tube 12 and collet 56. Thereciprocating member 54 generally has a bore 57 to connect with theguidewire tube 12. The arrangement described protects the guidewire fromdirect exposure to the electrical components of the system. This guardsagainst current leakage onto the guidewire.

A specific embodiment of the invention is illustrated in FIGS. 9 and 10.Referring now to FIG. 10, the reciprocating member 54 is a reciprocatinglever 58 which reciprocates the guidewire tube 12. The reciprocatinglever 58 has a first end 59, a second end 60, a socket 61, and a groove62 in the second end which operatively engages with the cam 53 totranslate the cam orbital motion to reciprocating motion. Thereciprocating lever 58 reciprocates about its fulcrum 64. The socket 61extends through the reciprocating lever 58 and is sized to mate with anexpanded section 63 on the guidewire tube 12. This allows the guidewiretube 12 to reciprocate with the reciprocating lever 58 while remainingfree to rotate around the guidewire tube longitudinal axis. The socket61 is shown in dashed lines in FIG. 10 to better illustrate the expandedsection 63 on the guidewire tube 12.

Illustrated in FIGS. 10-13 is a rotating lock ring 70 which attaches toa first externally threaded cylindrical extension 71 on the housing 11and which can be rotated to prevent the guidewire tube 12 from rotatingabout its longitudinal axis. The rotating lock ring 70 is best shown inFIG. 13 and has a plurality of arms 72, having outer sides 73 and innersides 74, which extend diagonally down into the core 76 of the lock ring70 to form an opening 77 through which the guidewire tube 12 extends. Aboss 78 having an inner face 79 is provided on the housing 11, and whenthe lock ring 70 is rotated and moved into the locked position the innerface 79 of the boss 78 contacts the outer sides 73 of the arms 72,forcing the arms inward and narrowing the opening 77 formed by the arms72. FIG. 10 shows the rotating lock ring 70 in a locked position inwhich the guidewire tube 12 will contact the arms 72 if rotation isattempted but remains free to reciprocate longitudinally through theopening 77. FIG. 13 shows the rotating lock ring 70 in the unlockedposition in which the arms 72 are not in contact with the boss 78. Thematerial used for the arms 72 should be such that bending of the arms 72when in the locked position does not exceed the elastic limit of thematerial so that they will not permanently deform when in the lockedposition.

FIG. 12 shows a cross-sectional view of the rotating lock ring 72 alonglines 12--12 in FIG. 10, and illustrates a most preferred embodimenthaving four arms forming a square opening through which a guidewire tube12 having four flat sides extends. Other lock ring configurations whichreversibly alter the opening through which the guidewire tube 12 extendsmay be suitable. For example a lock ring with an axis offset from theguidewire tube's axis and with an opening that is circular with two flatsides meeting to form an angle of about 90°, will allow guidewire tuberotation when the guidewire tube is close to the circular region of theopening but prevent it when rotation of the lock ring moves the flatsides closer to the guidewire tube (not shown).

Referring again to FIG. 10, a rotating cap 81 may be provided which isthreaded onto the housing 11 of the vibration device which may be usedto change the stroke length of the reciprocating lever 58. The rotatingcap 81 is attached to a pivot block 82 and cap rotation imparts linearmotion to the pivot block. The pivot block is attached to thereciprocating lever 58 at a point of contact which varies as therotating cap 81 is rotated and the pivot block 82 is linearly displaced.This point of contact is the fulcrum 64 on which the reciprocating lever58 reciprocates so the rotating cap 81 and pivot block 82 togetherchange the stroke length of the reciprocating lever 58 by changing thelever's fulcrum 64.

FIG. 10 best illustrates a rotating luer ring 90 which attaches to asecond externally threaded cylindrical extension 91 on the housing 11and which can be rotated to impart longitudinal motion in the guidewiredelivery catheter 14 along an axis parallel with the guidewirelongitudinal axis without imparting rotational or longitudinal motion tothe guidewire 13. The guidewire 13 is slidably received in the lumen 92of a tubular support member 93 attached to the rotating luer ring 90 anda luer fitting 94. A guidewire delivery catheter 14 may be attached tothe device 10 at the luer fitting 94, and rotating the luer ring 90imparts longitudinal motion in the tubular support member 93, the luerfitting 94, and the delivery catheter 14, but not in the guidewire 13positioned within the delivery catheter 14. FIG. 14 illustrates theaction of the rotating luer ring 90 at line 14a--14a, and the maximumdistance of adjustment of the delivery catheter position is about 10millimeters or more.

As illustrated in FIG. 1, the housing 11 of the vibration device 10 issized and shaped to fit comfortably in the operator's hand. Inoperation, the button 55 on the housing 11 is pushed to activate thereciprocating member 54. The guidewire 13 is pushed through a stenoticsegment of a vessel as seen in FIG. 1. The guidewire 13 may be securedto the device at the collet 56 and reciprocated, and it is free torotate even though it is secured to the device. This freedom to rotateresults in a vibration device with superior guidewire steerability andease of use. A delivery catheter 14 may be extended and retractedrelative to the guidewire 13 while the guidewire is secured to thedevice 10, and the delivery catheter may have stiffness and distal endcurvature configuration that can be varied while the catheter systemremains in the patient.

What is claimed is:
 1. A guide wire vibration device, comprising:(a) ahousing having an interior chamber; (b) a drive motor secured within theinterior chamber of the housing having a rotary output shaft; (c) a camoperatively connected to the output shaft of the motor to convert therotating output of the rotary output shaft to reciprocating motion; (d)an elongated reciprocating member having first and second ends and beingoperatively engaged at the first end with an operative surface of thecam for reciprocating therewith and pivotably connected at the secondend; (e) a guidewire tube which has proximal and distal ends, a lumenconfigured to slidably receive a guidewire and which is secured to thereciprocating member between the proximal and distal ends thereof, sothat the guidewire tube reciprocates with the reciprocating member alonga longitudinal axis of the guidewire tube; and (f) a means for securingthe guidewire within the guidewire tube, whereby the guidewirereciprocates with the guidewire tube.
 2. The guidewire vibration deviceof claim 1, wherein the first end of the reciprocating member has achannel defined at least in part by a groove therein which receives thecam.
 3. The guidewire vibration device of claim 1 wherein the means forattachment of the guidewire tube to the reciprocating member includes anexpanded section centered on a point which bisects the longitudinal axisof the guidewire tube.
 4. The guidewire vibration device of claim 3wherein the reciprocating member has a transverse bore extending throughit which is configured to mate with the guidewire tube expanded sectionfor connecting the guidewire tube to the reciprocating member, wherebythe guidewire tube reciprocates with the reciprocating member along theguidewire tube's longitudinal axis but remains free to rotate around theguidewire tube's longitudinal axis.
 5. The guidewire vibration device ofclaim 1, wherein the guidewire attachment means comprises a releasablycollet which is attached to the guidewire tube and mounted on a proximalside of the device.
 6. The guidewire vibration device of claim 1,further comprising means to vary the stroke of the reciprocating lever.7. The device of claim 6 wherein the means to vary the strokeincludes:(a) a rotating cap threaded onto the housing of the vibrationdevice; and (b) a pivot block attached to the rotating cap such that caprotation about an axis of the cap imparts linear motion to the pivotblock parallel to the cap's axis of rotation, and connected to thereciprocating lever such that the fulcrum of the reciprocating lever isshifted by rotation of the cap, whereby rotation of the cap varies theangle at which the reciprocating lever pivots.
 8. A guidewire vibrationdevice of claim 1 wherein the guidewire tube has flat sides and meansfor attachment to the reciprocating member, so that the guidewire tubereciprocates with the reciprocating member along a longitudinal axis ofthe guidewire tube but remains free to rotate around the guidewiretube's longitudinal axis;a first externally threaded cylindricalextension on a proximal side of the device is positioned so that theguidewire enters the device through the first threaded extension; arotating lock ring is threaded onto the first threaded extension and hasa plurality of arms, having outer sides and inner sides and tops, withthe top of the arms being fixed to the rotating lock ring forlongitudinal travel with the rotating lock ring and the arms extendingdiagonally down into the core of the rotating lock ring forming anopening in the rotating lock ring core through which the guidewire tubeextends; and a boss is fixed to the housing of the device having aninner face adjacent to the arm outer sides, so that when rotation of therotating lock ring moves the arms longitudinally towards the device theboss inner face contacts the arm outer sides forcing the arms inward, sothat when the rotating lock ring bottom is flush against the device thearm inner sides move into proximity with the guidewire tube, therebypreventing rotation of the guidewire tube but not preventing theguidewire tube longitudinal vibration.
 9. A guidewire vibration device,comprising:(a) a housing having an interior chamber; (b) a drive motorsecured within the interior chamber of the housing having a rotaryoutput shaft; (c) a cam operatively connected to the output shaft of themotor for converting the rotary output of the rotary output shaft toreciprocating motion; (d) a reciprocating member having first and secondends with the first end operatively engaged with an operative surface ofthe cam to facilitate reciprocation therewith; (e) a guidewire tubesecured to the reciprocating member having a lumen configured toslidably receive a guidewire, so the guidewire tube reciprocates withthe reciprocating member along a longitudinal axis of the guidewire tubebut remains free to rotate around the guidewire tube's longitudinalaxis; (f) a means for securing the guidewire to the guidewire tube,whereby the guidewire reciprocates and rotates with the guidewire tube;(g) a second externally threaded cylindrical extension on the distalside of the device positioned so that the guidewire emerges from thedevice through the second externally threaded cylindrical extension; (h)a rotating luer ring threaded to attach onto the second threadedextension, so that rotating the luer ring moves it towards and away fromthe guidewire vibrating device along an axis parallel with the guidewirelongitudinal axis; (i) a tubular support member having a lumen, beingpositioned so that the guidewire emerges from the vibration devicethrough the tubular support member lumen, and being secured to therotating luer ring for longitudinal movement with the rotating luerring; and (j) a luer fitting attached to the tubular support member, forreleasably connecting a guidewire delivery catheter to the tubularsupport member, whereby rotation of the rotating luer ring impartslongitudinal movement in the guidewire delivery catheter independent ofthe guidewire.